Prognosis communication in serious illness: Perceptions of older patients, caregivers, and clinicians
Prognosis communication in serious illness: Perceptions of older patients, caregivers, and clinicians
复制标题
DOI：
10.1046/j.1532-5415.2003.51457.x
复制
发表时间：
2003-10-01
影响因子：
6.3
通讯作者：
O'Leary, J
中科院分区：
文献类型：
--
作者：
Fried, TR;Bradley, EH;O'Leary, J
目的：检验患者、护理人员和临床医生在预后沟通方面的一致性，并检验患者和护理人员对预后信息的需求。
设计：横断面调查。
地点：参与者家中。
参与者：214名60岁及以上因癌症、充血性心力衰竭或慢性阻塞性肺疾病而预期寿命有限的患者、护理人员以及临床医生。
测量：患者 - 临床医生和护理人员 - 临床医生关于预后讨论发生情况的一致性，以及患者和护理人员对预后信息的需求。
结果：在46%的患者/临床医生组合和34%的护理人员/临床医生组合中，临床医生报告称已告知患者可能死于潜在疾病，而患者或护理人员则报告未进行过此类讨论。在23%的患者/临床医生组合和30%的患者/护理人员组合中，临床医生报告讨论过大致的预期寿命，而患者或护理人员报告未进行过讨论。在205名报告未讨论过预期寿命的患者中，40%不想进行此类讨论。认为自己还能活1年或更短时间的患者中有83%想讨论预后，认为自己能活1 - 2年的患者中有79%、认为自己能活2 - 5年的患者中有53%、认为自己能活5年以上或不愿回答的患者中有50%想进行此类讨论（P = 0.007）。
结论：尽管临床医生报告称他们在讨论预后，但患者和护理人员经常不认可这些报告。此外，许多患者不想要预后信息。尽管先前有报告得出患者希望全面了解自身疾病的结论，但许多重病老年人和护理人员可能没有准备好或无法接受预后信息。
OBJECTIVES: To examine agreement between patients, caregivers, and clinicians regarding prognosis communication and to examine patients' and caregivers' desire for prognostic information.DESIGN: Cross-sectional survey.SETTING: Participants' homes.PARTICIPANTS: Two hundred fourteen persons aged 60 and older with a limited life expectancy secondary to cancer, congestive heart failure, or chronic obstructive pulmonary disease; caregivers; and clinicians.MEASUREMENTS: Patient-clinician and caregiver clinician agreement about the occurrence of prognosis discussions and patient and caregiver desire for prognostic information.RESULTS: In 46% of patient/clinician and 34% of caregiver/clinician pairs, the clinician reported saying that the patient could die of the underlying disease, whereas the patient or caregiver reported no discussion. In 23% of patient/clinician and 30% of patient/caregiver pairs, the clinician reported discussing an approximate life expectancy, whereas the patient or caregiver reported no discussion. Of 205 patients who reported no life expectancy discussion, 40% did not want this discussion. Whereas 83% of those believing they had 1 year or less to live wanted to discuss prognosis, 79% of those believing they had 1 to 2 years, 53% of those believing they had 2 to 5 years, and 50% of those believing they had more than 5 years or who were unwilling to answer wanted this discussion (P = .007).CONCLUSION: Although clinicians report that they are discussing prognosis, patients and caregivers frequently do not corroborate these reports. Furthermore, many patients do not want prognostic information. Despite previous reports concluding that patients want full disclosure about their illness, many seriously ill older persons and caregivers may not be ready or able to receive prognostic information.